Graves Eye Disease, Interferon and Blindness

[ArtieChoke]

I've been seeing a reputable hepitologist for HCV-genotype 2 induced stage 4 liver disease with mild portal hypertensive gastropathy, and excellent liver synthetic function. He is reluctant to put me on interferon/ribavirin therapy which would last 48 weeks, because of the risk of blindness from Graves Eye Disease. Although I have been euthyroid for four years, I was treated for hyperthyroidism from 2000-2002 with atenolol, tapizole and PTU, and currently have clinical evidence of mild Graves eye disease in one eye, demonstrated by lid retraction, and slight limitation of upward and outward gaze. He feels that Graves eye disease can be devastating in this setting and may not improve following withdrawal of therapy and councils me to wait and see if my liver stabilizes and new treatments become available. I am a 62 year old female, otherwise in good health, but had been drinking up until a year ago, so my liver has had that much time to stabilize from lab results that were taken at that time and every three months since. I was cleared by the ophthalmologist for interferon therapy, my TSH and T4 are normal, and the endocrinologist says she will monitor me. My hepititologist says he will leave the decision up to me, but says that if he were I, he wouldn't risk going on interferon, at least, not at this time. I'd like to know what you think about this issue, and/or, if you can advise me on where I can find, and/or who might be able to answer, detailed questions about the risk of blindness due to interferon therapy. Thank-you.

[Sandy Feldman, MD, MS]

DearArtieChoke,

I would recommend that you seek a second opinion to determine the benefit and risks of treatment.  

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[Michael J Kutryb, MD]

From my experience, the Mayo Clinic has been on the cutting edge for thyroid eye disease treatment so that would be a solid starting point for a second opinion.  Interferon treatment is not easy and is a prolonged treatment with lots of time for complications to occur.  You would need to be in the best possible shape to be able to complete the course and the Grave's issue definitely raises a red flag.  I cannot offer any opinion here on what to do but second opinions are usually a good idea.

MJK MD